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General NPI Number Information
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NPI Number | 1689660243
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Entity Type | Organization
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Legal Business Name | NORTHSIDE HOSPITAL PHARMACY AT MERIDIAN MARK
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Dates
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Enumeration Date | 09/20/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5445 MERIDIAN MARKS RD NE STE 190
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City | ATLANTA
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State | GA
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Zip | 30342-4763
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Country | US
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Telephone | 404-459-1740
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Fax | 404-459-1745
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Provider Business Mailing Address
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Address Line | 5445 MERIDIAN MARKS RD NE STE 190
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City | ATLANTA
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State | GA
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Zip | 30342-4763
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Country | US
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Telephone | 404-459-1740
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Fax | 404-459-1745
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Authorized Official
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Title or Position | PHARMACIST
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Name | KATHRYN HORTON JACKSON
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Credential |
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Telephone | 404-459-1740
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | PHRE008289
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License Number State | GA
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